Diabetes Care Standards

[Kalista Pierce]

Good Afternoon,

Do you have a Diabetic Care Standard policy or protocol that allows ordering by nurses for things such as A1c testing, Alb/Cr nephropathy testing, Diabetic Eye exam referrals, Metabolic panel for those on ACE/ARB/Diuretics, and perhaps even statin use? If so, could you please share this protocol or policy used within your organization?

Any and all feedback is helpful.

Thank you,

Kalista Pierce, MBA, BS

Quality Support Coordinator

Clinical Quality & Patient Safety

[bugya90, ASN, BSN, LVN, RN]

We have a protocol for lab order for DM. A1c every 3-6 months depending on previous result (if above 8 then 3 months, if below 8 then 6 months), Micro albumin yearly, BMP/CMP and Lipid screening every 6 months.

We can also refer for DM eye exam yearly.

We can refer to Podiatry for a yearly DM foot exam as well, however most of our PCPs will do the foot exam in office at the follow-up.

We do not have protocol for initiating any medications as that requires prescriptive authority and evaluation by a provider. Keep in mind there are many different statins and there are risks with any medication. Our providers use the AVSCD risk score to determine statin appropriateness.

For nursing to order, the patient must be an established patient at our clinic, brand new patients must be seen by PCP prior to labs. The patient must have been seen within the past 6 months or have an upcoming follow-up appointment scheduled with our clinic. We require our patients with DM to be seen every 3-6 months so it is usually not an issue.

[lpn164]

At my office, I work with one provider under a large hospital organization. He and I have a standing order for most general disease processes. For Diabetes we do a1c q3-6 months, micro albumin q1 year unless contraindicated, referrals to ophthalmology, foot exams and referral out to podiatry if needed. I happily sign off on these orders with a VORB (verbal order read back) per our standing established orders. Pt's on BP meds will usually do a BMP with our 6 month orders, lipids and CMP q 6 months for cholesterol, PSA yearly unless urology is doing them, thyroid we do tsh & t4 q 6 months if on meds current and if no meds yearly tsh w/ reflex to t4. We no longer do urinalysis unless symptoms of any urinary disease are present. Hope this helps!

[Kalista Pierce]

Thank you so much for the feedback!!

Would you be willing to share this document? We are currently working to try and create this process as well.

Thanks!